Provider Demographics
NPI:1366677395
Name:CENTRE STREET PHARMACEUTICAL LLC
Entity Type:Organization
Organization Name:CENTRE STREET PHARMACEUTICAL LLC
Other - Org Name:BUY-RITE PHARMACY V
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-980-2615
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4408
Mailing Address - Country:US
Mailing Address - Phone:212-343-1919
Mailing Address - Fax:212-343-2888
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:UNIT 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4408
Practice Address - Country:US
Practice Address - Phone:212-343-1919
Practice Address - Fax:212-343-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6451530001Medicare NSC